Over the past several months, we’ve seen mental health at the center of the conversation about telehealth – particularly ADHD and the common medications used to treat the condition. These conversations arose from the telehealth mental health startups that sprung up during the height of the Covid-19 pandemic when clinics shuttered and left many patients looking for ways to get and maintain treatment.
Several of these telehealth startups are under investigation by the Department of Justice and Drug Enforcement Administration, citing business and treatment practices that did not maintain quality ADHD and overall patient care. Some of the most recent stories paint a disturbing picture of patient care, sometimes with dire consequences.
While it may be easy to blame telehealth, the service itself is not overall detrimental to the healthcare system. It provides a much-needed outlet for patients who often have no other option – patients who now are questioning where they can turn for care.
Providers May Have Disappeared – but Patients Haven’t
In light of the recent investigations, many of these virtual providers have disappeared or halted prescribing common ADHD medications, which are classified as schedule II drugs.
But the patients they were treating have not gone anywhere.
According to a recent article, there were upwards of 200,000 patients registered by one telehealth provider alone. With the ongoing investigations and halting of prescriptions by many pharmacies, that equals thousands of patients losing access to the medication and care they need. This adds to the ongoing mental health crisis, especially among young people, we see today.
For ADHD patients, this lack of access is detrimental to their mental and physical health. It is already a relatively complex and time-consuming process to receive an ADHD diagnosis and treatment, regardless of whether they are taking medication. Add a prescription to the process, especially with the current medication shortage, and the process becomes even more cumbersome.
Where do these patients turn to tackle these hurdles?
It’s Not Telehealth – It’s a Scaling Problem
As stated earlier in this piece, telehealth is a viable option for many patients with ADHD or other mental health concerns. The problem is most telehealth startups’ ineffectiveness in scaling their solution to manage the caseload.
Telehealth startups grew at a rapid pace, to the point where they could not adequately keep up with the number of patients coming through the virtual doors. This led to mismanagement and mis-staffing that got us to the point we are at today.
But private clinicians can combat these issues by implementing telehealth services in their practices – the clinic I serve implemented its own telehealth program and has been offering this service since the start of the pandemic. It is understandable that some providers are hesitant when first approaching telehealth for ADHD care. Some may not feel comfortable managing ADHD patients in a remote setting or lack the right assessment tools to get a clear diagnosis.
But adding virtual capabilities is more common than ever before and allows us to serve our patient populations better and potentially reach more patients in need of vital care. We can seamlessly offer telehealth appointments because we are taking the time to have the right technologies, trained staff and better processes to manage cases and keep patients – not profit – at the heart of what we do.
From a staffing perspective, utilizing technology allows general practitioners and nurse practitioners to enhance their skills and be more integral providers, especially for patients looking for mental health and ADHD care. We are becoming increasingly relied upon in the field and leveraging technology like objective ADHD testing, which allows us to have a reliable first line of testing to determine the next steps for a patient. It gives us more confidence in our diagnosis and helps ensure patients are on the right diagnostic and treatment path. Objective tests often can be conducted in a telehealth setting with provider supervision, as well as in the clinic.
In addition, many technology providers, like those who offer objective testing, provide invaluable resources and clinical support to ensure that all healthcare providers – are properly equipped for optimal patient care.
However, we are encountering challenges from state and federal-level roadblocks as we come to the potential end of the public health emergency. As with the telehealth startups, physicians offering telehealth appointments in some areas are prohibited from prescribing schedule II drugs, including common ADHD treatments. Some providers shifted to entirely virtual practices for the safety and comfort of their patients but now cannot give them the necessary ADHD and mental health treatment based on these restrictions.
How to Provide Adequate Care in a Telehealth Setting
Many ADHD patients want the option to use telehealth to receive their care and treatment – they just need it to work.
For telehealth startups to be effective, they need to implement the same strategies as private practitioners at scale so they can manage caseloads while providing optimal care. An integral piece of that puzzle is proper staffing to ensure patients speak with a qualified healthcare professional who can handle issues promptly and responsibly, like a licensed nurse practitioner. There also is a need for better tools and resources that improve the model of care and tackle the stigmas surrounding ADHD and treatment, like standardizing objective testing that can help providers rule in or rule out a patient’s diagnosis.
Providers and telehealth startups need better cooperation from state and federal agencies to manage concerns and restrictions so they can treat patients needing care. Cutting out a provider’s virtual practice during a patient’s treatment could be mentally and physically detrimental, regardless of if they suffer from ADHD or any other mental health issue.
Collaboration is needed throughout the industry to create the best model for telehealth – from startups to private practices – so we can meet the care gap facing hundreds of thousands of mental health patients in the U.S. today.
Angela Stuff
Angela Stuff, PMHNP-BC, is a dual board-certified family and psychiatric mental health nurse practitioner. In 2017, Angela graduated from Walden University with her Masters of Science in Nursing (MSN) with a focus as a Family Nurse Practitioner (FNP).
While working as an FNP, Angela witnessed the lack of and growing need for mental health providers as well as her desire to help this population. After a few years of practice as an FNP, she returned to school and graduated from Liberty University with her post-masters licensure as a PMHNP.
Angela has a strong belief that care should be individualized for each person and strives to build a therapeutic relationship with each patient. While dedicated to evidence-based practices and treatments, she aspires to not only help improve the mental health of each patient, but also help improve their overall health and well-being.